Spontaneous Rupture of a Hepatocellular Carcinoma: Is a Liver Transplant Indicated?

Arjona, Tatiana Prieto-Puga; López, Laura Romacho; Muñóz, Miguel Ángel Suárez; Pérez, Belinda Sánchez; Santoyo, Julio Santoyo

doi:10.1016/j.cireng.2015.06.005

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…The patient received LDLT 11 months after the bridging period, while downstaging of HCC with three cycles of TACE and no recurrence was observed 20 months after the operation. Data and outcomes of previous studies on LT after HCC rupture and our present study results are described in Table 3 (13)(14)(15)20). The present study contributes significantly to the field compared to previous case reports because this study had multiple cases treated with a similar protocol at a single center and was limited to patients who received a liver from a living donor.…”

Section: Discussionmentioning

confidence: 87%

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Outcomes of Living Donor Liver Transplantation in Patients With a History of Ruptured Hepatocellular Carcinoma

Lee

Hong

et al. 2021

Front. Surg.

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Background: Liver transplantation (LT) is considered a contraindication in patients with a history of hepatocellular carcinoma (HCC) rupture because ruptured HCCs are classified as T4 in the current American Joint Committee on Cancer TNM system. This study aimed to assess living donor liver transplantation (LDLT) in these patients and elucidate the factors that may have affected their outcomes.Methods: Data of patients with a history of ruptured HCC who underwent LDLT between January 1999 and December 2019 were retrospectively reviewed.Results: Among 789 patients who underwent LDLT for HCC, five (0.64%) had a history of HCC rupture. Three patients (60%) were treated with transarterial chemoembolization (TACE) or transarterial embolization (TAE) for hemostasis, and two patients (40%) achieved spontaneous hemostasis. One of two patients who achieved spontaneous hemostasis underwent surgical resection and LT at 1 week and 6 years after the rupture, respectively. The other patient underwent LT 2 days after the rupture. Four patients (80%) survived for >5 years, while two patients (40%) experienced recurrence and succumbed during the median follow-up duration of 85.3 months (range, 12.4–182.7). The recurrence first developed at 4.3 and 17.0 months after LT; these patients were managed well using surgical resection for peritoneal seeding and TACE for intrahepatic HCC.Conclusion: LDLT can be considered a treatment method even in patients with a history of HCC rupture after full evaluation of tumor biology and risk of recurrence.

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Section: Discussionmentioning

confidence: 87%

“…There are only a few case reports on LT in patients with HCC rupture (13)(14)(15) and without evaluation of any biological markers. We experienced favorable outcomes in some patients with selective tumor biology.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Living Donor Liver Transplantation in Patients With a History of Ruptured Hepatocellular Carcinoma

Lee

Hong

et al. 2021

Front. Surg.

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Rupture of Hepatocellular Carcinoma: A Review of Literature

Sahu

Chawla

Dhiman

et al. 2019

Journal of Clinical and Experimental Hepatology

105

110

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Approximately 700,000 people die of Hepatocellular Carcinoma (HCC) each year worldwide, making it the third leading cause of cancer related deaths. Rupture is a potentially life-threatening complication of HCC. The incidence of HCC rupture is higher in Asia and Africa than in Europe. In Asia approximately 10% of patients with a diagnosis of HCC die due to rupture each year. Spontaneous rupture is the third most common cause of death due to HCC after tumor progression and liver failure. The diagnosis of rupture in patients without history of cirrhosis or HCC may be difficult. The most common symptom of ruptured HCC is abdominal pain (66-100%). Shock at presentation can be seen in 33-90% of cases; abdominal distension is reported in 33%. Abdominal paracentesis documenting hemoperitoneum is a reliable test to provisionally diagnose rupture of HCC, it can be seen in up to 86% of clinically suspected cases. The diagnoses can be confirmed by computed tomography scan or ultrasonography, or both in 75% of cases. Careful pre-treatment evaluation is essential to decide the best treatment option. Management of ruptured HCC involves multidisciplinary care where hemostasis remains a primary concern. Earlier studies have reported a mortality rate of 25-75% in the acute phase of ruptured HCC. However, recent studies have reported a significant decrease in the incidence of mortality. There is also a decrease in the incidence of ruptured HCC due to improved surveillance and early detection of HCC. Transarterial Embolization is the least invasive method to effectively induce hemostasis in the acute stage with a success rate of 53-100%. Hepatic resection in the other hand has the advantage of achieving hemostasis and in the same go offers a potentially curative resection in selected patients. (J CLIN EXP HEPATOL 2019;9:245-256) INCIDENCE The reported incidence of HCC rupture shows a distinct global variation. In the West, the incidence of HCC is increasing but HCC ruptures are relatively uncommon, with an incidence of less than 3%. 12-14 However, in Asia and Africa, the incidence is considerably higher, ranging between 3% and 26%. 14,15 The incidences of ruptured HCC reported from around the globe are 10% from Japan, 12.4% from Thailand, 12.7% from southern Africa, 14.5% from

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Spontaneous Rupture of a Hepatocellular Carcinoma: Is a Liver Transplant Indicated?

Cited by 2 publications

References 9 publications

Outcomes of Living Donor Liver Transplantation in Patients With a History of Ruptured Hepatocellular Carcinoma

Outcomes of Living Donor Liver Transplantation in Patients With a History of Ruptured Hepatocellular Carcinoma

Rupture of Hepatocellular Carcinoma: A Review of Literature

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